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Two discussion papers on domiciliary care commissioning and procurement
- Author:
- OXFORD BROOKES UNIVERSITY. Institute of Public Care
- Publisher:
- Oxford Brookes University. Institute of Public Care
- Publication year:
- 2016
- Pagination:
- 45
- Place of publication:
- Oxford
Two discussion papers on domiciliary care commissioning and procurement, produced by the Institute of Public Care the for the Social Services Improvement Agency for Wales (SSIA) and the National Commissioning Board for Wales (NCB). The first discussion paper explores some of the opportunities and challenges presented by taking an outcomes-based approach to the commissioning of domiciliary care. It looks at possible service- and individual-level outcomes, the role of re-ablement, the role and nature of providers in the care market, and measuring the performance of domiciliary care providers. It concludes by suggesting a set of design rules for commissioners who want to take an outcome-based commissioning approach to domiciliary care. The second discussion paper sets out the options available to local authority commissioners for the procurement of services, focusing on domiciliary care services and supported living services for people with learning disabilities. It covers the relationship between commissioning and procurement, EU and UK procurement requirements, and different models of procurement. (Edited publisher abstract)
A survey of consultant psychiatrists in intellectual disability based in England
- Authors:
- GUINN Ashley, et al
- Journal article citation:
- Advances in Mental Health and Intellectual Disabilities, 10(4), 2016, pp.258-270.
- Publisher:
- Emerald
Purpose: Community mental health services are of increasing importance for people with an intellectual disability (ID), as the government aims to reduce the number of people treated within inpatient services. However, due to limited evidence base, it is unclear which service models are most effective for treating people with both ID and a mental health condition. Therefore, the purpose of this paper is to carry out a survey in order to gain a better understanding of the current state of ID community services. Design/methodology/approach The survey was e-mailed to 310 consultant psychiatrists based in England and whose main specialism was in ID. In total, 65 consultants responded to the survey with 53 complete data sets. Findings: In total, 84 per cent of consultants identified themselves as working in a generic community ID team. The majority of services were not integrated with social care (71 per cent). Regional differences were found. In contrast to the rest of England, the majority of services in London were integrated with social care. The Health of the Nation Outcome Scale for people with Learning Disabilities (HoNOS-LD) was found to be the most common outcome measure used by services. A range of interventions are widely available across services including psychological therapies and specialist memory assessments. The survey also provides evidence for increased decommissioning of specialist inpatient units and a need for more robust community services. Research limitations/implications: Findings limited by low return rate (21 per cent) and because responses could not be matched to specific services. The implications of this survey are that there is still a variable level of integration with social care and that lack of integration could affect the quality of service. While HoNOS-LD is used consistently across services, there may be a need to supplement it with other outcome measures. There is a need for larger scale and higher quality studies in this area to strengthen the evidence base and therefore demonstrate the benefits of integration and specialisation more convincingly to health professionals and commissioners. Originality/value: This survey presents an overview of the current state of community services for adults with ID in England. This information can be harnessed to add to revised approaches to mental health service models for people with ID. (Publisher abstract)
Perceived barriers and facilitators to positive therapeutic change for people with intellectual disabilities: client, carer and clinical psychologist perspectives
- Authors:
- RAMSDEN Sarah, et al
- Journal article citation:
- Journal of Intellectual Disabilities, 20(3), 2016, pp.241-262.
- Publisher:
- Sage
- Place of publication:
- London
Studies have highlighted successful outcomes of psychological therapies for people with intellectual disabilities. However, processes underlying these outcomes are uncertain. Thematic analysis was used to explore the perceptions of three clinical psychologists, six clients and six carers of barriers and facilitators to therapeutic change for people with intellectual disabilities. Six themes were identified relating to: what the client brings as an individual and with regard to their wider system; therapy factors, including the therapeutic relationship and adaptations; psychologists acting as a ‘mental health GP’ to coordinate care; systemic dependency; and the concept of the revolving door in intellectual disability services. The influence of barriers and facilitators to change is complex, with facilitators overcoming barriers and yet simultaneously creating more barriers. Given their potential impact on the psychologists’ roles and access to therapy for people with intellectual disabilities, findings suggest these factors should be formulated as part of the therapeutic process. (Publisher abstract)
Relocating people with intellectual disability to new accommodation and support settings: contrasts between personalized arrangements and group home placements
- Authors:
- McCONKEY Roy, et al
- Journal article citation:
- Journal of Intellectual Disabilities, 20(2), 2016, pp.109-120.
- Publisher:
- Sage
- Place of publication:
- London
Internationally the relocation of people with intellectual disability from institutions has brought significant gains to their quality of life. This study contrasted three groups of persons in Ireland who moved either to personalised arrangements (n = 29) or to community group homes (n = 31) with those who remained in congregated settings awaiting relocation (n = 29). Persons moving to rented accommodation with personalized support tended to be younger and had fewer support needs than those in group homes. They had greater control and choice in their lives, more community engagement and increased personal relationships compared to residents in group homes but those remaining in congregated settings fared worse of all. However, average staff costs were significantly higher in the latter settings. The implications for the future provision of group living arrangements are discussed along with the need for further longitudinal research to assess the sustained impact of personalized arrangements and their funding. (Edited publisher abstract)
Commentary on “Training in positive behavioural support: increasing staff self-efficacy and positive outcome expectations”
- Author:
- PADDEN Ciara
- Journal article citation:
- Tizard Learning Disability Review, 21(2), 2016, pp.103-107.
- Publisher:
- Emerald
Purpose: The purpose of this paper is to provide a commentary on Stocks and Slater’s paper, “Training in positive behavioural support: increasing staff self-efficacy and positive outcome expectations”. Design/methodology/approach: This is a narrative review of staff training in positive behaviour support (PBS) and challenging behaviour, drawing on Stocks and Slater’s paper and the core staff competencies outlined in the PBS Competence Framework (PBS Coalition, 2015). Findings: Taking into consideration multiple outcome measures, including staff outcomes such as self-efficacy, changes in staff behaviour, and the impact on quality of life for service users, may provide a broader insight into the effects of staff training. Supports and systems such as hands-on training, supervision, and practice leadership are also important factors that are likely to lead to positive service user and staff outcomes. Originality/value: This commentary reflects on Stocks and Slater’s paper in the broader context of staff training outcomes and factors that contribute to high-quality services for people with learning disabilities and challenging behaviour. (Publisher abstract)
Named Social Worker: baseline report
- Author:
- INNOVATION UNIT
- Publisher:
- Great Britain. Department of Health
- Publication year:
- 2016
- Pagination:
- 19
- Place of publication:
- London
The first report from an evaluation of six pilot sites set up to develop, implement and evaluate a Named Social Worker for people with learning disabilities, autism and mental health needs. The Named Social Worker programme was initiated by the Department of Health to develop an understanding of how having a named social worker can contribute to individuals with learning disabilities, autism or mental health needs achieving better outcomes. The Innovation Unit and the Social Care Institute for Excellence are working with the six local authority pilot sites, who are: Calderdale Council, Camden Council, Hertfordshire County Council, Liverpool City Council, Nottingham City Council and Sheffield City Council. This report brings together the core theory of change hypothesis that each of the six sites is testing, looks at the models each authority is using and provides an analysis of emerging themes. It also provides an outline of the programme’s approach to evaluation and mini case studies illustrating different elements of implementation. (Edited publisher abstract)
Development of self-help, language, and academic skills in persons with Down syndrome
- Authors:
- DE GRAAF Gert, DE GRAAF Erik
- Journal article citation:
- Journal of Policy and Practice in Intellectual Disabilities, 13(2), 2016, p.120–131.
- Publisher:
- Wiley
Using visual analysis by means of scatterplots, correlational analysis, and linear regressions, the authors explored the skills of individuals with Down syndrome in the areas of self-help, language, academics, and computer skills. By combining data of several Dutch studies, they obtained 1,252 different observations made by parents on 862 individuals, aged <1–35 years. Research shows advancement in language skills up to the age of 12, with plateauing afterward. In contrast, self-help skills still increase in adolescence and young adulthood. Academics and computer skills improve up to the age of 14. However, less developed academic skills (and computer skills) of adolescents and young adults appear to be a generational difference, rather than a loss of acquired skills. In their analysis, the authors differentiated between students with a primarily regular school career vs. those with a primarily special school career. In addition, in both groups, the studies were differentiated between students with an IQ >50 vs. an IQ between 35 and 50. The comparison between the various subgroups revealed that children with special education backgrounds in the higher IQ range demonstrated less advanced academic skills than children with regular education backgrounds in the lower IQ range. This suggests that regular education is more stimulating for academic skill development. Using age, “school career,” and IQ (<35; 35–50; 50–60; 60–70; >70) as predictors, regressions confirmed this conclusion. The authors conclude that their analyses show that the shift in the early 1990s in the Netherlands toward more inclusion in education for students with Down syndrome has led to better outcomes in academic skill development for these students. (Publisher abstract)
Positive behaviour support: what model of disability does it represent?
- Authors:
- GREY Ian, LYDON Helena, HEALY Olive
- Journal article citation:
- Journal of Intellectual and Developmental Disability, 41(3), 2016, pp.255-266.
- Publisher:
- Taylor and Francis
Positive behaviour support (PBS) has become well established as an intervention approach for individuals with intellectual disability and challenging behaviour. However, what remains unexplored is the relationship between PBS and the medical and social models of disability, which historically are the dominant conceptual frameworks put forward in understanding disability. This paper identifies the difficulties in exploring this relationship due to the often simplistic portrayals of such models. Though PBS has a change agenda, typically a characteristic of the medical model, it is change at an ecological level that is central to PBS. An analysis of the practices of PBS demonstrates a concern with pragmatically identifying the interaction between person and environment to reduce the occurrence of challenging behaviour. PBS practices are considered to be more aligned with a supports model because they build an individual ecology of support tied to meaningful quality of life outcomes for individuals with challenging behaviour. (Publisher abstract)
Commentary on “Can active support improve job satisfaction?”
- Author:
- DEVEAU Roy
- Journal article citation:
- Tizard Learning Disability Review, 21(2), 2016, pp.61-64.
- Publisher:
- Emerald
Purpose: The purpose of this paper is to provide a commentary on Rhodes and Toogood’s article on the possible relationship between Active Support training and staff job satisfaction. Design/methodology/approach: Rhodes and Toogood unusually and importantly include outcomes for both frontline staff and service users following an Active Support intervention. This commentary builds upon this approach by drawing on ideas recently raised by Deveau and McGill (2015). Findings: A number of important themes are identified including the mutuality of direct support staff (DSS) and service user experience, the significance of considering both the formal and informal aspects of organisational culture and the value of employing a complexity theory perspective. Originality/value: Effective public services require an understanding of the factors influencing the behaviour of public service staff. In intellectual disability services, positive outcomes can only be obtained through a broader appreciation of the drivers of DSS behaviour, especially the roles played by culture and leadership.
A community forensic team for people with intellectual disabilities
- Authors:
- BROWNING Morna, GRAY Rosemary, TOMLINS Rose
- Journal article citation:
- Journal of Forensic Practice, 18(4), 2016, pp.274-282.
- Publisher:
- Emerald
Purpose: The purpose of this paper is to explore the characteristics of adults with intellectual disabilities supported by a Community Forensic Learning Disability Team (CFT) and interventions delivered. It discusses the clinical implications of these and examines outcomes such as recidivism. Design/methodology/approach: A retrospective case note review of all 70 service users open to the CFT during June 2013 was carried out, using a structured service evaluation tool. Findings: The majority of service users (74.3 per cent) had a mild intellectual disability. Multiple mental health and/or physical health diagnoses were common, and 28 per cent had problematic drug or alcohol abuse. Almost half of service users had been victims of physical or sexual abuse, or neglect. Sexual offences were the most common index offence, followed by assault and fire-setting. A wide range of multi-disciplinary interventions were delivered within the Community Forensic Team. Following CFT involvement there was an increase in service users living in supported living in the community and a decrease in people in secure or out of area placements. Over half of service users engaged in no further offending behaviour since their referral, and those who did offend generally showed a decrease in the severity of offending behaviours. There was a large decrease in the number of convictions received. Practical implications: The study shows the benefits of a multi-disciplinary Community Forensic Team for offenders with intellectual disabilities in terms of reduced recidivism and range of interventions delivered. It highlights the importance of clinicians within such a team having the skills to work with people with co-morbid diagnoses (e.g. autism) and people with trauma backgrounds and problematic substance use. Originality/value: This paper demonstrates the complexity of the service users who are supported by the CFT, as well as the integral role played in supporting individuals to move to less restrictive settings, with positive outcomes. (Publisher abstract)